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Blood Conservation Techniques - Hemoconcentration > 2F5 > Flashcards

2F5 Flashcards

(42 cards)

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1
Q

hemoconcentration definition

A

use of membrane to concentrate blood components by removing plasma water

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2
Q

what is hemoconcentration driven by?

A

convection and transmembrane pressure

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3
Q

hemofiltration definition

A

use of membrane in conjunction with fluid replacement to reduce the concentration of water-soluble components of plasma

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4
Q

what is hemofiltration driven by?

A

convection and transmembrane pressure gradient between blood and ultra filtrate side of membrane

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5
Q

hemodialysis definition

A

use of membrane in conjunction with fluid dialysate to remove water-soluble components from plasma

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6
Q

what is hemodialysis driven by?

A

diffusion gradient across the membrane

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7
Q

ultrafiltration definition

A

generic term for the removal of plasma water and its soluble components from blood via convection

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8
Q

what is “ultrafiltrate”

A

fluid removed

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9
Q

what is hemoconcentration used for on CPB

A

to effective remove excess fluid in the ECC

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10
Q

what does hemoconcentration help control?

A

circulating volume and HCT

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11
Q

hemoconcentration helps maintain ____ pressure by….

A

helps maintain oncotic pressure by retaining plasma proteins and removing excess plasma water

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12
Q

what is Pre-Buf?

pre-CPB ultrafiltration of pump prime

A

addition of banked blood to prime

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13
Q

when would blood to prime in Pre-Buf be harmful?

A

to neonate patients who blood volume less than prime volume

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14
Q

how is primed circuit blood delivered?

A

under pressure into the ultrafilter

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15
Q

how is ultra filtrate handled to maintain operating level in reservoir?

A

removal balanced with addition of balanced electrolyte solution

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16
Q

what is conventional ultrafiltration (CUF)?

A

means of managing CPB circuit volume and increasing hematocrit without bank blood

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17
Q

how is CUF set up during CPB

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A

receive blood from high-pressure arterial side of circuit and return blood to low-pressure venous side of circuit

18
Q

what is a consideration when using conventional ultrafiltration?

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A

must have adequate volume in venous reservoir to safely remove ultra filtrate and maintain optimal flows during CPB

19
Q

when is CUF used?

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A
  • after aortic declamp
  • during rewarming
  • UF in parallel with CPB
  • Inlet after the oxygenator
  • UF blood return into venous reservoir
20
Q

what are the advantages of CUF

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A
  • does not delay surgical times

- removes UF during highest mediator production phase

21
Q

what are the disadvantages of CUF

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A

it might quickly empty reservoir volume

22
Q

what are the continuous ultrafiltration replacement

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A

ZBUF
HVUF
DUF

23
Q

what is ZBUF

24
Q

what is HVUF

25
what is DUF
dilutional
26
what is the goal of continuous ultrafiltration replacement?
goal to remove 3-6 L of ultra filtrate
27
when do you ultrafiltrate?
at 200 ml/min during rewarming
28
what is the post CPB ultrafiltration?
MUF
29
what is MUF used for?
technique developed to reduce total body water and tissue edema that results after pediatric CPB
30
what is AV-MUF
blood from aorta pumped through filter returned to RA
31
what are alternative MUF configurations? .
VV MUF | VA MUF
32
considerations for MUF
- delays protamine administration | - possible air entrapment in AV MUF
33
what are the advantages of MUF
significantly high efficiency
34
what are the disadvantages of MUF
- cumbersome procedure - patient cooling - hemodynamic instability
35
potential role of UF in post CPB
capillary leak syndrome
36
what is possibly removed in post CPB UF
inflammation mediators | -C3a, C5a, IL-6a, IL-8a, TNF, MDF, ET-1
37
what else could possibly result from UF in post CPB
total body water reduction - tissue edema decrease - hematocrit increase - coagulation factors concentration - decreased need of hemoderivates
38
UF on left ventricular function
1. myocardial edema decrease 2. DO2 increase 3. left ventricular compliance increase 4. systolic and diastolic function improvement
39
what is monitored for hemodialysis during CPB
monitoring of patient's blood electrolytes and metabolites | monitoring of arterial shunt created for dialysis as to not reduce actual blood flow to patient
40
what is circuit salvage post CPB
preserves plasma proteins and coagulation factors -heparin will be in rein fusion product so protamine reversal doses must be considered
41
what is sieving coefficient?
defines its movement across a membrane as value of S approaches 1.0, its ability to diffuse through membrane increases
42
sieving coefficient equation
S = drug concentration in ultrafiltrate/ drug at filter inlet

Blood Conservation Techniques - Hemoconcentration (2 decks)

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